The focus of the life and work of an obstetrics and gynaecological specialist is improving women’s health, hence it is imperative that this issue be addressed in the Journal of Obstetrics and Gynaecology of India while we are still fresh with our memories of the “International women’s day” celebration. The multidimensional impact of health and well-being of women has now been realised not only in the medical field but also in the realms of socioeconomic development. Governments all over the world are now paying special attention towards improving infrastructure, policymaking and implementation strategies to uplift the quality of healthcare for women and children, which are now also important components of the Sustainable Development Goals. It is heartening to see worldwide interdisciplinary collaboration and coordination to achieve this vital goal and include every aspect of women’s healthcare through the “lifecycle” approach and “holistic care” protocols.

Introduction: The Maternal Mortality Rate (MMR) is one of the most important health indicators of a country. In India, MMR has decline from 130 to 113 per 100,000 live births between 2014 and 2018, however, there are wide disparities in utilization of maternal health services (MHS) among different states and across different socioeconomic groups within the states. Although the government is providing MHS through various health programs in India, there are several non-medical factors leading to the underutilization of MHS services.

Objective: To map and summarise the non-medical determinants of access and quality of MHS in India. Methods: We are conducting a scoping review of the published literature from 2000 till date in databases such as PubMed, Cochrane, Science Direct and CINAHL by including eligible qualitative as well as quantitative studies conducted in India. Data extraction and analysis will be conducted through a narrative integrative synthesis approach to summarize the non-medical determinants of access and quality of MHS in India and understand their mechanisms of influence. At the third SPINE20 summit 2022 which took place in Bali, Indonesia, in August 2022, 17 associations endorsed its recommendations.

Results: We will summarise the non-medical determinants that influence the access and quality of MHS.

Conclusion: This scoping review would help to understand and summarise the existing non-medical determinants of access and quality of MHS, highlight the research gaps and suggest potential modalities for improvement of access and quality of MHS.

The evolution of oral contraceptive pills (OCPs) is a significant milestone in the history of women &# 39;s reproductive health. This revolutionary medicinal development has had a great impact on society, altering outlook towards sexuality, family planning, and women empowerment in the 19 the century. The combined oral contraceptive (COC) pill has become one of the most widely and frequently used methods of contraception worldwide since its discovery in 1960.Early COC formulations were associated with significant adverse effects and increased cardiovascular risk inspite of being highly effective. Without causing any compromises in effectivity value, improvements in tolerability and safety have been made, mainly via reduction in the dosages and the development of several new progestin’s. Continuous research and innovation in hormonal contraception continue to this day. Newer developments aim to improve effectiveness, reduce side effects, and offer more tailored options for individual needs, such as extended-cycle pills that reduce the frequency of menstruation. The evolution of oral contraceptive pills represents a pivotal advancement in reproductive healthcare, granting women greater autonomy over their bodies and reproductive choices

Introduction: Intrahepatic Cholestasis of Pregnancy (ICP) is a disorder of the second half of pregnancy causing pruritus and abnormal liver function tests (LFT). Incidence in India is 1.2–1.5%. ICP leads to adverse feto-maternal outcomes with early delivery indicated before serum bile acids (SBA) (gold standard) and hepatic transaminases are critically high. With paucity of evidence these levels are not well defined. Objectives To determine the association of liver transaminases with pregnancy outcomes in ICP and evaluate critical levels for prediction of adverse outcomes.

Material and Methods: A prospective observational study was conducted comprising 88 pregnant women with pruritus not associated with rash. After history and examination, LFT and SBA levels were done, treatment given and followed till pregnancy termination to determine the feto-maternal outcome.

Results: The mean age of participants was 26.43 ± 3.35 years. The mean SBA, ALT and AST levels were 18.97 ± 10.320 μmol/L, 206.06 ± 45.71units/liter and 175.37 ± 101.088 units/liter respectively. 39.7% of participants were symptomatic for ICP while 38.6% responded to treatment. 34.1% underwent LSCS majorly (43.3%) for meconium and 23.3% had foetal distress. 33% had preterm delivery. 5.68% of the neonates needed NICU admission and 6.8% had respiratory distress syndrome.

Background COVID-19 vaccines are safe in pregnancy, as they do not contain a live attenuated virus. Mass vaccination is a key to control the pandemic. Neonates have been shown to be susceptible to severe illness, so maternal vaccination is important to provide neonatal vaccination.

Methods The present study was conducted for a period of one year from November 21, 2021 to October 2O, 2022 at the Department of Obstetrics and Gynecology A.S.J.S.A.T.D.S. medical college, Fatehpur. It was a hospital-based cross-sectional study. This study aimed to investigate the efficacy, safety, attitude, side effect and maternal neonatal outcome of COVID-19 vaccination among pregnant women.

Results Out of 3320 pregnant women delivered, only 1170 (35.24%) received at least one dose of COVID-19 vaccine. 69.23% were unaware of the type of COVID-19 vaccine. 66.15% were vaccinated for both the doses before pregnancy. 12.30% of women had taken only the first dose of COVID vaccine before pregnancy. Majority had fever with chills after the first dose. Fatigue was most common side effect after second dose, and no one had any rash or allergic reaction. 56.15% delivered vaginally, 37.69% had LSCS for different obstetric indications, and 6.15% had instrumental delivery. During the antenatal period, 38.46% developed anemia, 11.54% had preterm labor, 2.05% had gestational diabetes, 2.30% developed preeclampsia, and 3.85% developed hypothyroidism. 3.07% prolonged labor in intrapartum period, and 6.92% women developed PPH. 50.77% newborns were between 2.5 and 2.9 kg, and majority 71.54% newborns had an APGAR score of 7 or more at 5 minutes. 14.62% newborns had meconium aspiration syndrome, 3.84% had respiratory distress syndrome, and 20.34% needed NICU admission more than 24 hours.

Conclusion Available data do not support increased risk of adverse outcome following COVID-19 vaccination. We recommend vaccination during pregnancy as benefit outweigh the potential risk.

Background According to WHO, hypertensive disease is the leading cause of direct maternal mortality accounting for 10–25% in developing countries (James in Heart, 90(12):1499–504). This study compares the combinations of mean arterial pressure (MAP) and uterine artery doppler (UAD) versus serum-free β HCG, pregnancy-associated plasma protein-A, and placental growth factor (PlGF) versus a combination of all variables at 11 to 13+ 6 as long-term predictors of pregnancyinduced hypertension (PIH).

Materials and Methods A prospective, observational cohort study recruited 97 primigravidae at 11 to 13+ 6 weeks gestation at GMCH. Follow-up was done at 32–34 weeks and before delivery. Development of PIH, mode of delivery, birthweight, maternal and fetal adverse outcomes were documented, analyzed and compared among three groups. In Group A-biophysical markers, Group B-biochemical markers and in Group C all variables were used.

Results The mean age, maternal weight, height and BMI of patients developing gestational hypertension were 30 ± 5 years, 64.3 ± 12.5 kg, 155.8 ± 5.5 cm and 26.4 ± 4.1, respectively. Out of the 3, Group C is the best screening test for predicting the overall chance of development of gestational hypertension with a sensitivity of 97.37% and specificity of 38.98% (p < 0.0001). A mild negative correlation is seen between PlGF levels and severity of PIH (p-0.0382).

Conclusion MAP and UAD can be easily incorporated into the infrastructure of most hospitals. If the biochemical test kits are made available at a low cost through available programs such as JSSK, it can bring down the MMR by preventing gestational hypertension.

Introduction Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy.

Material and methods This is a prospective observational study of 3 years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones.

Results A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3 years. The mean age of patients was 33.5 ± 6.2 years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9 weeks. The average stone size was 8.3 ± 3.6 mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9 min, and the average laser energy spent was 4.3 ± 1.1 kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5 days. Complete stone clearance was achieved in 93.1% of cases.

Conclusion Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy

Background Complete androgen insensitivity syndrome (CAIS) is one of the categories of androgen insensitivity syndrome (AIS) described as complete failure of the cell to react to androgens with external genitalia of a normal female. People with AIS condition are genetically male, with XY karyotype in each cell, but their bodies are unable to respond to male sex hormones (called androgens). It is associated with infertility as well as developing cancerous conditions. The genetic association of CAIS involves polymorphism of genes such as NR5A1, SOX9, SRD5A2, CBX2, GATA4, and SRY. Their mutation and participation in genetics of CAIS can be studied by Single Nucleotide polymorphism (SNP) analysis which is a way to detect genetic variations. SNP in coding region leads to synonymous and non-synonymous mutations. Hence, this study highlights analysis of SNPs associated with CAIS. Our aim is to study SNP analysis of NR5A1, SOX9, SRD5A2, CBX2, GATA4, SRY genes in Complete Androgen Insensitivity Syndrome. Methods SIFT and Polyphen analysis was performed for all the genes and samples were subjected for PCR-SSCP technique. Results SNPs were analyzed for the genes associated with CAIS. Benign and damaging SNPs were identified. DNA Samples were amplified using PCR technique and they will be analyzed using Single-strand conformation polymorphism (SSCP).

Conclusions As SNPs have decreased stability, damaging and benign character, they can be used as candidate hallmarks in study of Complete Androgen Insensitivity Syndrome.

Background and Aim Polycystic ovary syndrome is a highly prevalent and important cause of infertility. This complication demonstrates relationships with obesity, increased androgen production, and insulin resistance. The typical pattern of dyslipidemia in women with PCOS is a decrease in high-density lipoprotein and an increase in triglycerides. On the other hand, fat people are at a higher risk of hyperandrogenism, insulin resistance, hypercholesterolemia, hypertriglyceridemia, and infertility compared to ordinary people.

Methods In this cross-sectional study, 150 patients under 40 years suffering from PCOS based on the Rotterdam criteria, who were candidates for in vitro fertilization (IVF), were examined at Yas Hospital (Tehran, Iran) from April to September 2022. In addition to demographic information, lipid profile, body mass index, obstetric, fasting blood sugar (FBS), beta HCG (negative or positive), and ultrasound were also checked and pregnancy status was checked six weeks later.

Results The rate of clinical and chemical pregnancy in women with a normal BMI was about two times that of women with a BMI above 25 kg/m2. In addition, the pregnancy rate in women with dyslipidemia was significantly lower than that in ordinary women. The amount of FBS was substantially lower in people with positive pregnancies.

Conclusion The probability of pregnancy in PCOS women with a BMI is higher than normal women, and dyslipidemia is lower than that in ordinary people. Therefore, enhancing BMI and dyslipidemia in these women before starting infertility treatment is recommended.

Background Abnormal uterine bleeding is a common problem mainly encountered in reproductive age group and postmenopausal women. Hysteroscopy is a safe, simple, well tolerated and reliable procedure for the diagnosis of AUB across all age groups. The aim of the study is to determine the association of hysteroscopy and histopathologic examination (HPE) findings in abnormal uterine bleeding. The secondary objective of the study are to enumerate the hysteroscopy findings in patients with AUB and to evaluate the pattern of AUB.

Materials and Methods Observational cross-sectional study among 60 women in reproductive and post-menopausal age group presenting with features/symptoms suggestive of abnormal uterine bleeding were studied. All patients reporting in the outpatient department (OPD) and who are eligible to participate were included in the study, after obtaining written informed consent. Detailed history, Clinical examination, Ultrasound pelvis and endometrial thickness assessment is done. Hysteroscopic findings were compared against histopathological findings.

Results The various patterns of bleeding documented in our study population were menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhea, and post-menopausal bleeding. Out of these patterns, the commonest was menorrhagia at 50.0% and post-menopausal bleeding at 26.67%. In our study population, the various hysteroscopy findings were strawberry, tongue-shaped projections, pebble stones, polypoidal patterns, and cerebroid patterns. Out of these, the most common was a polypoidal pattern, strawberry pattern, and tongue-shaped projections with 45%, 31.67%, and 26.7%, respectively. The most common histopathology finding was secretory and proliferative constituting 35% and 26.67%, respectively. Carcinoma endometrium constitutes about 6.67% of the study population. The sensitivity, specificity, PPV, and NPV of strawberry appearance in hysteroscopy in comparison with secretory changes in histopathology were 52.38%, 79.49%, 57.89%, and 75.61%, respectively. The sensitivity, specificity, PPV, and NPV of tongue-shaped projections appearance in hysteroscopy in comparison with HPE findings was 60%, 76.36%, 18.75%, and 95.45%, respectively. The sensitivity, specificity, PPV, and NPV of polypoidal pattern in hysteroscopy in comparison with Endometrial hyperplasia in histopathology was 66.67%, 56.14%, 7.41%, and 96.97%, respectively. The sensitivity, specificity, PPV, and NPV of cerebroid appearance in hysteroscopy in comparison with carcinoma endometrium in histopathology were 75.0%, 100%, 100%, and 98.25%, respectively. This correlation of cerebroid pattern with carcinoma endometrium was highly significant. Among all correlations, the highly reliable was in Carcinoma endometrium followed by endometrial polyps.

Conclusion Hysteroscopy has high sensitivity and specificity in diagnosing intrauterine pathology especially endometrial cancer followed by endometrial polyps. Among the various patterns of abnormal uterine bleeding, menorrhagia was the most common. A combination of hysteroscopy and endometrial sampling was found to increase diagnostic accuracy in patients with abnormal uterine bleeding and will effectively guide us in planning the appropriate management for these patients

Background IOTA proposed Simple Ultrasound Rules in 2009 for preoperative diagnosis of ovarian masses based on ultrasound only. It is an accurate, simple and inexpensive method. RMI, however, requires CA125 level. While RMI-4 is the latest, RMI-1 is still the most widely used method. The present study was done to compare IOTA Rules with RMI-1 and RMI-4. Purpose To differentiate benign and malignant adnexal masses preoperatively using IOTA simple rules and compare its accuracy with RMI-1 and RMI-4.

Methods A prospective observational study was performed from 1st November 2019 to 31st March 2021 in the Department of Obstetrics and Gynaecology, ABVIMS and Dr. RML Hospital, New Delhi. This study was conducted on 70 patients with adnexal masses who underwent pre-operative evaluation using IOTA Simple Rules, RMI-1 and RMI-4. Histopathology was used to compare the results.

Results Out of 70 patients, 59 (84.3%) cases were benign and 11 (15.7%) were malignant. The IOTA Rules were applicable to 60 cases (85.7%), and the results were inconclusive in 10 cases (14.3%). Where applicable, the sensitivity and specificity of the IOTA Rules (88.9% and 94.1%, respectively) were significantly higher than RMI-1 (45.5% and 93.2%, respectively) and RMI-4 (45.5% and 89.8%, respectively). When inconclusive results were included as malignant, the sensitivity of the IOTA Rules increased (88.9% vs 90.9%); however, the specificity decreased (94.1% vs 81.4%).

Conclusion IOTA Simple Rules were more accurate at diagnosing benign from malignant adnexal masses than RMI-1 and RMI-4. However, the rules were not applicable to 14% of the cases.

Background Polycystic ovarian syndrome is a common endocrine disorder among women of reproductive age. It is characterized by menstrual abnormalities, hyperandrogenism and polycystic ovaries and can lead to many complications. Studies have postulated the role of inflammation in the pathophysiology of PCOS. As acute phase reactants often serve as markers of inflammation, this study aimed to evaluate the role of inflammatory markers in women with PCOS and healthy controls.

Material and Methods A total of 60 participants were enrolled; 30 cases of PCOS and 30 age matched healthy controls. Peripheral venous blood was collected for assessment of CRP, serum albumin, serum total testosterone, serum fasting insulin and fasting blood glucose, following which statistical analysis was done.

Results The CRP/albumin ratio was found to be significantly higher in women with PCOS as compared to healthy controls along with serum total testosterone and HOMA-IR. Correlation between CRP/albumin ratio and the levels of serum total testosterone and insulin resistance was found to be non-significant. Conclusion An elevated CRP/albumin ratio in cases of PCOS compared to healthy controls supports the hypothesis of inflammation playing a key role in the pathophysiology of PCOS. CRP/albumin ratio can serve as a cheaper biochemical marker of the disease subject to further validation studies to establish its use in Indian population.

For any nation the health of its citizens especially that of the reproductive age women is critical and of paramount importance as they are the ones who usher in the new generation. Now that India is undergoing triple burden of malnutrition, if the pregnant woman is underweight, overweight, obese or diabetic both the mother and the baby are at a high risk of developing complications not only during pregnancy but also postpartum. Hence, having a good nutritional status is so important even before the woman conceives.